June 4, 2023

A board-certified internal medicine physician reviews how opioid drugs change the brain and lead to dependence by taking over your brain’s mu opioid receptors. We review how opioid addiction is typically a chronic disease of the brain requiring long-term treatment.

Why are certain drugs so addictive and why are some people more likely to get addicted than others and how much of this risk is due to genetics how can an opioid drug such as morphine alter your brain structure sometimes permanently after just using it for one month how do these changes in the brain cause the chronic disease that we know is addiction hi i’m dr

Maria conley today i’d like to focus on opioid drugs although obviously there’s many other addictive drugs out there such as alcohol and nicotine and cocaine for example all of these drugs can cause permanent changes in the structure and function of the brain even after just one month of use this explains why opioids are so dangerous and why opioid addiction is

Really a chronic disease much like diabetes or hypertension permanent changes in your brain structure cause permanent changes in the way that you feel and act opioids have been used by humans for over 3 500 years in fact ancient sumerian medical texts written on clay tablets referred to the opium poppy as the joy plant morphine and codeine are naturally occurring

Compounds from the opium poppy while other opioids are synthetic including heroin oxycodone methadone hydrocodone fentanyl and buprenorphine all of these drugs bind to the mu opioid receptors in the brain to exert their effects the human body actually produces its own natural opioids including endorphins and cufflins and dinorphins so what’s a drug it’s what a drug

Is any substance that you put into your body that causes the change in the way that you feel or in the way that your body functions drugs yet are injected straight into your veins such as heroin or inhaled directly into the lungs such as crack cocaine tend to be more addictive because they affect the brain almost immediately drugs act by attaching to receptor

Molecules on specific cells in your body addictive drugs target brain cells otherwise known as neurons so what does a neuron look like so imagine a neuron is an uprooted tree lying on the ground with its branches and its roots visible so there’s just millions of these in the in the brain and when you take an opioid such as oxycodone it goes straight to the brain

And it binds to receptor on one of these neurons which triggers an electrical or chemical signal to pass from that neuron to another one and this is how brain cells communicate the signal may activate or inhibit the next neuron and eventually cause some action to occur such as the release of a neurotransmitter like dopamine or serotonin the balance of these

Chemicals in the brain often affects our thoughts and emotions the way that a substance makes you feel depends on the type of receptor that it binds to in the brain for example opioids bind to mu receptors on opioid sensitive neurons which tends to cause a feeling of euphoria and peacefulness when you first take it so how does this happen well virtually all

Drugs of abuse initially cause happy feelings by stimulating the release of dopamine in the brain dopamine is a neurotransmitter that is released normally when you’re doing fun things like eating good food or experiencing a runner’s high dopamine is released through the mesolimbic reward pathway of the brain this pathway involves groups of neurons in the limbic

System which is located deep in the middle of the brain when an opioid drug enters your brain it triggers neurons in the ventral tegmental area of the midbrain to dump large amounts of dopamine into other areas of the brain including the nucleus accumbens the prefrontal cortex the hippocampus and the amygdala and these remember these are all just specialized

Groups of neurons in the brain the dopamine release into the nucleus accumbens causes that initial drug high and the feeling of wanting more repeated use of the drug gradually activates more neurons in the prefrontal cortex which is that area of the brain that’s responsible for decision making and this explains why people with addiction often make poor decisions

Lack control over their behavior and can have difficulty with learning and memory normally your body’s natural opioids including endorphins stimulate dopamine release when you do something pleasurable but when you take manufactured opioids such as oxycodone or morphine these drugs actually cause your brain to release an unnaturally high amount of dopamine so in

Essence what happens is that these opioid drugs take over the mule receptors in your brain and your brain gets used to these abnormally high levels of dopamine and it gradually becomes less responsive to natural rewards such as you know a runner’s high or eating good food so what happens is that your brain actually produces less of these natural opioids because

You’ve been feeding it so much of the synthetic opioid drug so when you try to stop taking the opioid drug you experience symptoms of withdrawal and you start to crave the drug and at this point you need to actually take the drug again to get rid of those terrible feelings of what’s wrong so now unfortunately you’ve created another problem for your body the same

Drug that initially gave you pain relief and euphoria when you initially took it has now taken control of your brain’s reward system now you’re not even going to feel normal unless you take the drug addiction can be seen as a state in which you’re continually seeking the drug to avoid withdrawal symptoms such as nausea vomiting diarrhea insomnia and depression

Anyone who takes an opioid regularly for more than a few days will have withdrawal symptoms when they try to stop taking it this is called dependence so it can be very difficult to distinguish between opioid dependence in opioid addiction psychiatrist bible of diagnosis known as the dsm-5 uses 11 different criteria to diagnose a substance use disorder or drug

Addiction a quick way to remember these diagnostic criteria are the four c’s control compulsion craving and continued use despite consequences if you are losing control of your drug use and taking more than prescribed feeling compelled to use the drug even when you want to stop it craving the drug or continually using the drug even though it’s causing problems

In your life you may be addicted it’s important to remember that addiction is a brain disease it’s not due to some lack of moral character that doesn’t mean you’re a bad person it actually changes your brain in approximately 40 to 50 percent of your risk for developing addiction is inherited twin studies have revealed that the heritability of addiction ranges

From 39 percent for hallucinogens to up to 72 percent for cocaine there’s no question that opioids change the structure of the brain and and how it works for example multiple studies have shown that people who use prescription opioids daily for just one month show a significant loss of brain cells in that area of the brain called the amygdala when when you look

At the brain imaging such as on mri the amygdala is that part of the brain in the limbic system which regulates how you think and feel malfunction of the limbic system brought on by addiction can cause cognitive impairment that can last for months to years after a person stops taking the drug and the most severe cases the cognitive impairment can be irreversible

Opioid addiction is a brain disease using opioid medications for just one month can profoundly alter your brain and bring about those changes that we commonly see with addiction including craving withdrawal and impaired decision making although opioid addiction tends to be a chronic relapsing disease we do have effective long-term treatment for it i’m talking about

Medication assisted treatment with methadone which is prescribed by licensed clinics or with buprenorphine naloxone which may be prescribed by any licensed physician nurse practitioner or physician assistant who has completed between 8 to 24 hours of training and has received a special waiver from the dea before you consider starting an opioid drug to treat pain

You should make an informed decision there’s a very real possibility that the drug can alter the structure of your brain and how it works perhaps permanently thank you for listening i hope that this has been helpful for you

Transcribed from video
Oxycodone vs. Endorphin: How Drugs Hijack Your Brain's Mu Opioid Receptors By Maria Conley MD